The Vaping Epidemic Is Getting Out of Hand

There is a certain perceived assurance e-cigarettes (e-cigs) are safe and harmless to your health. Unlike combustible cigarettes, the vapor is often odorless, making it difficult to detect once the e-cig device has been put away. While the number of people smoking traditional cigarettes has been dropping,1 the number of teens using e-cigs, also known as vaping, has steadily risen. Since 2011, teens have been smoking less and vaping more, and research demonstrates teens who vape may also be more prone to smoke.2

Tobacco Headlines Don’t Tell the Whole Story

Story at-a-glance

Unlike traditional combustible cigarettes that emit an offensive odor, electronic cigarettes, which are the most popular nicotine product among high school and middle school students, are generally misperceived as being safe and harmless to health

Data demonstrates adolescents who vape have a higher potential to begin using traditional cigarettes and may experience neurological changes, increasing their risk for developing addictive behavior as adults

Vapors from e-cigarettes are often odorless, but expose bystanders to toxic nicotine, heavy metals, fine particulate matter and formaldehyde

Although the FDA banned the sale of e-cigs to anyone under 18, the Trump administration halted enforcement allowing the tobacco industry time to launch an effort to roll back the regulation through legislation and litigation

Smokeless e-cigarettes are the most popular nicotine- or tobacco-based product used by high school and middle school students. The 2016 Surgeon General Report stated e-cigs are a major public health concern, as use from 2011 to 2015 in high school students had risen an astounding 900 percent.3

According to the most recent published National Youth Tobacco Survey, an estimated 3 million teens are vaping,4 representing a slight 11.3 percent decline in numbers of students smoking e-cigs since 2015, as compared to the 900 percent increase in the previous four years.5 Reports of declining e-cigarette use are based on this slim drop in numbers.

The 2016 National Youth Tobacco Survey also found many were using multiple tobacco products in the prior 30 days before the survey. While e-cigarettes were the most commonly used product for the third consecutive year, the current use of combustible cigarettes had not changed significantly.6 It’s important to realize that there’s no safe level of exposure to tobacco products, smokeless or combustible.

The U.S. Centers for Disease Control and Prevention (CDC) calls tobacco use the leading cause of preventable death.7 CDC acting director Dr. Anne Schuchat commented in a press release:8 “Far too many young people are still using tobacco products, so we must continue to prioritize proven strategies to protect our youth from this preventable health risk.”

Vaping May Have Lasting Effects on Health

In a yearlong follow-up of Los Angeles high school students, researchers discovered teens who use e-cigs are more likely to start smoking regular cigarettes.9 Stanton Glantz, tobacco control researcher from the University of California, San Francisco, has worried e-cigs were a gateway habit, leading teens to smoking traditional cigarettes, hookah and cigars.10 This study appears to confirm his concerns.

These results were supported by another study of more than 1,400 Connecticut high school students conducted over two years, during which researchers asked the students about their e-cig use and traditional tobacco cigarettes within the previous 30 days.11 Not surprisingly, they found those who reported smoking cigarettes during the first survey had a high likelihood of reporting during the second and third surveys as well. This was also true for students smoking e-cigarettes.

These results were not duplicated in those smoking only traditional cigarettes in the first survey. In other words, students were likely to move from vaping to traditional combustible cigarettes, but not vice versa. Researchers also found the overall use of both products increased over time. The authors outline some of the risks with e-cigs to teens when they wrote:12

“For example, adolescents may be more likely to use e-cigarettes before conventional cigarettes because of factors unique to e-cigarette products, such as perceptions that e-cigarettes are less harmful than conventional cigarettes, the widespread availability of unique e-cigarette liquid flavors that may be especially appealing to youth and limited enforcement or restrictions on youth access to e-cigarettes.”

Authors of a third study wrote e-cigarette users in their dataset were an intermediate risk for becoming smokers, speculating e-cigarettes may raise the possibility of recruiting adolescents who otherwise would be less susceptible to tobacco products.13 Another danger associated with smoking e-cigs is the ease of hiding the activity. As Dr. Sanjay Gupta points out in the video, students are hiding their activity in the classroom, hallways and bathrooms, and many parents likely do not know that they’re vaping.

Tobacco use is the leading cause of preventable death in the U.S. and Canada.14 Since smoking e-cigs leads to a higher potential of moving to traditional tobacco products, it’s critical to communicate the dangers of use with your adolescents and middle school students.

Cigarettes, e-cigarettes, cigars, dipping tobacco and hookah all qualify as tobacco products.15 The CDC states smoking causes more deaths each year than HIV, illegal drug use, alcohol, motor vehicle accidents and firearm-related accidents combined.16 Tobacco use is linked to these and many other conditions:17,18

Exposure at a Young Age May Increase Risk of Addictive Behavior

In a recent study from Perelman School of Medicine at the University of Pennsylvania,19 researchers used an animal model to evaluate if rats exposed to nicotine during adolescence would grow up to drink more alcohol than those who were not exposed. They found a positive result and discovered those who were only exposed during adulthood did not have the same propensity for an increase in alcohol consumption.

According to the researchers, exposure at a young age changed neurological circuitry in the brain within the reward pathway. Lead researcher John Dani, Ph.D., chair of neuroscience, commented the work was particularly important in light of the increasing use of vaping in high school and middle school students.20 Other research has demonstrated adolescent smoking is associated with an increased risk of alcoholism later in life.

As the biological basis for this was unknown, researchers from the University of Pennsylvania embarked on a study, administering nicotine to animals during adolescence and measuring alcohol self-administration of alcohol during adulthood.21

Nicotine administration during adulthood did not alter the function of the inhibitory midbrain circuitry in the same way it did with exposure during adolescence. The alteration in neurotransmitters is responsible for sending signals during stress or recognizing reward. Long-term changes in the midbrain reward center may also be a gateway to other addictive drugs, such as cocaine, heroin and morphine.22

Toxins Dangerous to Smokers and Bystanders

E-cigs are also associated with other health risks. In one study from Johns Hopkins Bloomberg School of Public Health,23 researchers examined devices owned by 56 users, finding a significant number generated unsafe levels of lead, nickel, chromium and magnesium. These results were consistent with previous studies,24 but they found larger amounts when liquid had been exposed to heating coils.25 Nearly 50 percent of the vapor samples had lead concentrations higher than limits set by the Environmental Protection Agency (EPA).26

While researchers found heating coils were made of nickel, chromium and other metals, the source of lead remains a mystery.27 Inhaled lead can attack your brain and nervous system, as well as kidneys, liver and bones.28 Lead may stay dormant in teeth and bones for years in adults, but may be reactivated during pregnancy, poisoning a developing baby and triggering brain damage. E-cigs create a nicotine-containing aerosol, which the user inhales in the vapor.

The vapor also includes flavor chemicals and gives the user an experience similar to that of traditional cigarettes, without high levels of offensive smelling polycyclic aromatic hydrocarbons. However, while there is no offensive odor, which may give bystanders a false sense of security, the vapor does pollute the air with nicotine and fine particulate matter easily absorbed by bystanders through inhalation.29

Despite lower levels of nicotine pollution from e-cigs, researchers found those exposed to vapor have similar levels of cotinine, a measure of the amount of nicotine taken into the body, as those exposed to traditional secondhand cigarette smoke.30

The reason for this discrepancy remains unclear. Vapor also contains acetaldehyde and formaldehyde.31 At least one brand had 10 times more than found in traditional cigarettes. The U.S. Food and Drug Administration (FDA) has detected the antifreeze chemical diethylene glycol in e-cig cartridges, also linked to cancer.32

According to Americans for Nonsmokers Rights, secondhand vapor may contain at least 10 chemicals identified on California’s Proposition 65 list of reproductive toxins and carcinogens.33 Probably the most well-known of these is diacetyl, an artificial flavor used by popcorn makers34 to add buttery taste to microwave popcorn. The chemical is linked to respiratory damage and permanent scarring of the airway.35 In an evaluation of 51 e-cig flavors, Harvard researchers found 47 contained flavoring chemicals, including diacetyl.36

American Lung Association Calls for Strong Efforts to Protect Health

The number of adolescents using smokeless tobacco devices and suffering subsequent health risks is a critical public health concern as it affects the future health of every community. The American Lung Association (ALA) State of Tobacco Control report for 201837 calls for significant and important action from state and federal agencies to move toward the elimination of tobacco use to positively impact the number preventable deaths in the U.S. and to reduce the pain and suffering experienced by smokers and their families. ALA president Harold Wimmer writes:38

“[W]ith more than 1 in 5 high school students still using at least one tobacco product, our nation’s youth are in continued danger of a lifetime of addiction and tobacco-caused disease, unless more is done to prevent and reduce tobacco use and protect against the harms of secondhand smoke.

The American Lung Association is committed to eliminating tobacco use and tobacco-related diseases. Our 16th annual ‘State of Tobacco Control’ highlights our progress toward this goal, and provides an urgent call to action for state and federal governments.”

In a press release statement in response to the 2016 National Youth Tobacco Survey, the ALA clearly calls for greater regulations and controls by the FDA as well as funding previously successful youth prevention programs:39

“Tobacco use is still the leading cause of preventable death and disease in the United States, killing close to half a million Americans every year. Now is not the time to make cuts to tobacco programs, when this study shows investments in prevention will reduce youth tobacco use and addiction. Our nation has worked too hard to reduce youth tobacco use to reverse course now.

Another key part of preventing youth tobacco use is oversight by the FDA. The Trump Administration must also allow the FDA to move forward with its full authority overall tobacco products in order to protect our youth from the flavored tobacco products designed and marketed specifically to attract kids, especially e-cigarettes and flavored cigars. The lives of our children and their futures are on the line, and we must do more to prevent and reduce tobacco use.”

FDA Disturbed by Statistics but Regulation of Sales Stalls

While e-cigs were originally designed as an alternative to traditional cigarettes for adults who were in a smoking cessation program, manufacturers of these devices are now targeting teens and acquiring a new generation of consumers. FDA Commissioner Scott Gottlieb told CNN chief medical correspondent Dr. Sanjay Gupta:40

“No kid should be using any tobacco product. We’re going to be taking some enforcement actions very soon to target companies that we think are marketing products in ways that they’re deliberately appealing to kids.”

However, as Gottlieb states in the video above, he hopes companies will make changes without FDA intervention:41

“Youth use is deeply concerning to me. We’re going to be taking some enforcement actions very soon to target companies that we think are marketing products and ways they’re deliberately appealing to kids. I’m going to be having conversations with some of these companies, trying to inspire them if I can to take more corrective actions on their own.”

In 2016, the FDA banned the sale of e-cigs to anyone younger than 1842 but the Trump administration quickly halted enforcement, allowing the tobacco industry time to launch an effort to roll back the regulation through legislation and litigation.43 A barrage of lawsuits against the FDA regulation on e-cigs sale to minors argues the rule violates the First Amendment as it treats nontraditional tobacco vaping products as if they were tobacco products regulated by the Tobacco Control Act.

Obviously, strict regulation on the sale of these devices to those younger than 18 would significantly impact the industry’s ability to expand their consumer base as more adults stop smoking traditional cigarettes. Not targeting their products at adolescents would likely reduce the industry’s revenue and appears to be out of the question.

How to Make Quitting Smoking Easier

I believe the “secret” to quitting smoking is to get healthy first, making quitting mentally and physically easier. Exercise is an important part of this plan, as research shows people who engage in regular strength training double their success rate at quitting smoking compared to those who don’t exercise.44 Healthy eating is another crucial factor to improve your health and strengthen your ability to quit. In short, if you want to quit, here are three basic tips to get started:

Find a healthy emotional outlet. Many use exercise, meditation or relaxation techniques for this, and these are all great. I also recommend incorporating Emotional Freedom Techniques (EFT). This can help clear out emotional blockages from your system (some of which you might not even realize are there), thus restoring your mind and body’s balance and helping you break the addiction and avoid cravings.

Once you are regularly doing these three things, then you may begin to think about quitting smoking as you have developed a foundational core on which to rely during the process. At this point many are ready to try quitting “cold turkey.” If you need a distraction, these six things to do instead of smoking may help. Finally, if you’re a parent, talk with your children about the risks of smoking, smokeless tobacco and e-cigarettes. The easiest path to not smoking is to avoid starting in the first place.